02030163 CITY OF CUPERTINO 1 Yt4 t,:t W'z t,,, Va.s
BUILDING DIVISION PERMIT CONTRACTORjINFORMATION
eun-11 ,A2USES;IMPERIAL AVE TAYLOR WOODROW HOMES PERMrrN(02030163
WNPAhrENOR WOODROW HOMES 2300 CAMINO RAMON APPLICATIONI/ L 6V2002
PHONE _779-27 36-5-3100 SANITARY NO. CONTROL NO.
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00LICENSED CONTRACTOR'S DECLARATION MR
O
OU
hereby affirm that 1 am licensed under previsions of Chapter 9(commencing NEW TOWNHOME CISIVS�ef && n ON
with Section 70(X))of Division 3 of the Business and Professions Cose,and my license is
to in fallfoweAndeffce,. 1456 SQ. FT. LIVING SPACE
oit2_ urease Class Lic.A
Date Conlmcaor 469 SQ. FT. GARAGE : $1zDm.,&, e®
F ARC]IITELTS DECLARATION
� ref I uWco,and my plamimAl k used As public records
u�LL60au 60 U 20U3
o Liccnsnd Pralcssional (';[jy
OWNER-BUILDER DECLARATION
t�s 7 1 hereby affirm that 1 am exempt Irom the Contractor'x License Law for the
i S 0 o following reason.(Section 71131.5.Business and Professions Code:Any city or county
$ which requires a Permit 1n construct.alter,improve,demolish,or repair any suucmm WILDING
'r+ prior 1.its issuance,also requires the applicant lar such prom it f lc A signed statement
ty—yZ� Ihalhe isliecamed pursuant to the provisions of the Contractor's License lawchapmr9 Sq. Ft. Floor Area $154Cr ILEktion
a� (commencing with Section TXXq of Division 3 of the Busimss and Professions Citt
A.03$ that he is exempt therefrom and the hasis for fie alleged exemption.Any vi.lation of
Section 71131.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(g58n), a U Occupancy Type
❑ 1.As.wnerOf he Property,or my employee.with wages as their sol.compensation,
will Jo the work,and the structure is not intended or offered for sale(Sec.7044,Business —
And Professions Code:The Contractors License Law does not Apply to an owner of 102 - PIERS egmred Inspections
property who builds or improves Thereon,and who does such work himself m through his
Own employees,provided that such improvements are not intended or offered for sale.If. 103 — UFER
however,fie building or improvement is sold within one year of completion,the owner-
builder will haw the burden of proving that he did not build or improve for purpose of
xah,)' 105 - ANCHOR BOLTS
2.r1-11 owner of fie property,am exclusively contracting with licensed contractors m 106 — SEWER & WATER
conswct the project(Sec.7(M4,Business and Professions Code:)The Contractor's Li-
mom Law does not apply to An Owner of property who Wilds orimprovismerton,and 202 - UNDERFLOOR PLUMBING
Lcense LaW0 for such projecu wit aconuumr(s)Gcenaeepursuenu.me Contractor's 203 — UNDERFLOOR MECHANICAL
Iam exempt undm Se.. .B 3k Pc ter refs masa" 204 - UNDERFLOOR FRAME
wn Date 205 - UNDERFLOOR INSULATION
WORTR'SCOME A ION uRATIo 301 — ROUGH PLUMBING
l herchy affirm under penalty of pe' ane ofine(...owing declarations: 302 — TUB & OR SHOWER
❑ Thaw Anil will maintain A Cambemeo Conammael6]nsurefnrWurkcr'sCnmpcn-
aation.M provided for by Section 370K)of the labor Code,for the Performance of the 3 03 - ROUGH MECHANICAL
warkfor which tia mthisissued, 304 - ROUGH ELECTRICAL
❑1 have and will maintain Wurkefs Compensation Insurance,as required by Section 305 — FRAME
370(1 of the labor Coda for the pmfnrmanec of the work for which his permit is issued.
My Worker's Compensation Insurance carrier And Policy num her am: 306 — HOLDOWNS
Carrier: I Policy No.: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORK FRY
COMPENSATION INSURANCE 308 - SHEETROCK
(This section need not the completed ifde permit is forame hundred dollars($100) 309 - EXTERIOR LATH
ir1C55) 310 - INTERIOR LATH
1 certify that in the perfmmantt of the work for which this Permit is issued,l shall not 311 - SCRATCH COAT
empl.yanyparttminanymanne 1ok�mra the Workers'ComPensalion
Law' 2m (JJ 313 - ROOF NAIL
Applicant �r�
NOTICE,TO PPLICANT:IL A ter making lits Crnifiwsati he LuM+lrlchn,yy, n�uw 501 — FINAL ELECTRICAL ENERGY
kcome withconvathe Worker pro Coons or this
Provision 502 - FINAL PLUMBING ENERGY
O O forthwith comply with such provisions or this permit shall k AcemcJ trunked.
ZCONSfRUCT10NLENDINGACENCY 503 - FINAL MECHANICAL ENERGY
F Iherthy affirm
All were is a construction lending agency for the Performance of 504 - FINAL BUILDING ENERGY
Ci > the work for which this peornaisissued lSce.31N],C.,C.)
Lender's Name 505 - FINAL ELECTRICAL
W Q
z Lcndcr'AAddress 506 - GAS TEST
UO 1mneethatlhavemadthis tyandcounmJstatematthe above information
ws"Wiin,is 507 - FINAL PLUMBING
W F correct,l Agree loaf I plyhave
ma all Airy and roomy ordinances the one nate laws
inf rmating m
C building conswction,and hereby auNmimmpresenlalwasofthis city toenterupon the 5 FINAL MECHANICAL
t' G above mc e)afire a save(n inspection purposes. 0 9 FIN
0. (We)egret to Arty indemnify and keep harmless the City of Cupertino against
ti fn
liabilities,judgments.costs and expenses which may in any way Accrue against said City S N G /� V
in
C.I APPLICANTrof the graphing of UNDERSTANDSthis Permit.AND WILL COMPLY WITH ALL NON-POINT Issued by, l I WORKS Date
SOURCE REGULATIONS
Re-roofs 603 - OF BATTENS
Signature of APPlicanl/Cnnt cter Dam
HAZARDOUS MAT, ISCLOSURE Type of R9(94 - ROOF IN-PROGRESS
Will Ne applicant or future buildin cupanlsmm or handle hASNow,materiel
as defined by the Cupertino Mun/icipal Cale.Chapter 9.13.and the Heabh and Safety
Code. El Yea 25532(.)? CSN All roofs shall be inspected prior to any roofing material being installed.
Yrs
Will the appliaam nr fuwrc building rocupam um eyuipmcm or devices which If a roof is installed without first obtaining an inspection, I agree to remove
Amit haeaN.us air emnaminanls as relined by the Bay Area Air Quality Management all new materials for inspection.
Dead,,' /
❑Yes []7
1 have read the hazrduus materials reynimments under Clear,6.95.1 the Cxlifnry
An Hcallb S Snfcty Cow,Sectons25S6,25533 and25534.1 underdone that fight building �(1 x / ./^I
does nal cunemly here A ahead,mal it is my responsibility t notify the occupant of me / f) 0
ter hich must hen uanre ofa Crnif¢ete of Qcupaney.
�i tsw ,O Signature of Applicant Date
owners a.moriatd a gent Date All roof Brings to he Class "B"or better